5PRIMARY HEALTH PHYSICIAN / FAMILY DOCTOR AND PUBLIC HEALTH

DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINEFACULTY OF MEDICINEPADJADJARAN UNIVERSITY

THE PRIMARY CARE DOCTOR IS WELL PLACED TO PARTICIPATE:CONTROL OF COMMUNICABLE DISEASESPREVENTIVE SERVICESTHE CONTROL OF DISEASE EPIDEMIOLOGYDESCRIPTIVE EPIDEMIOLOGYEXPERIMENTAL EPIDEMIOLOGYCONTROL OF NON-COMMUNICABLE DISEASESOUTBREAK INVESTIGATIONSPESIFIC PROTECTIONEARLY DETECTIONPROMPT TREATMENT

General Principles of Preventive Practice Preventive practice has been divided into three categories:Primary prevention increase a persons ability to remain free of disease.

Secondary prevention is the early detection of disease/ precursors of disease treatment can be started before irreversible damage

Tertiary prevention is the management of established disease minimize disability

the promotion of health and the prevention of illness, e.x.,immunisationand making physical environments safethe early detection and prompt interventionto correct departures from goodhealth or to treat the early signs of disease ex .,cervical screening, mammography,blood pressure monitoring and blood cholesterol checking

reducing impairments and disabilities, minimising suffering caused by existingdepartures from good health or illness, and promoting patients adjustment to chronicor irremediable conditions, e.x.,prevention of complications

PREVENTIVE SERVICES ( CANADIAN MEDICAL ASSOCIATION/ CMA, 1995)

HEALTH ENHANCEMENT: COUNSELING AND INFORMATION

RISK AVOIDANCE: ENSURING THAT PEOPLE AT LOW RISK REMAIN AT LOW RISK (IMMUNIZATION, ACCIDENT PREVENTION)

RISK REDUCTION: IDENTIFICATION OF INDIVIDUALS AT HIGH RISK IN ORDER TO HELP THEM REDUCE THE RISK

EARLY IDENTIFICATION OF DISEASE AT PRESYMPTOMATIC STAGE (~ SECONDARY PREVENTION)

COMPLICATION REDUCTION IN PATIENS WITH ESTABLISHED DISEASE (~ TERTIARY PREVENTION)

Why prevention???Population pyramid : Indonesia

USA

SEARO

SEARO

Pre-pathogenesis phasePathogenesis phaseEnvironmental and Social policiesAssessment of General Resistance Resources (GRR)Enhancement of GRR Risk Assessment Risk Reduction Presymptomatic diagnosis Early Diagnosis Rehabilitation to enhance recovery Care and support to maintain function and reduce further complications The health enhancement continuumPROMOTIVEPREVENTIVECURATIVEREHABILITATIVE PROMOTIVEPREVENTIVECURATIVEREHABILITATIVE PRIMARY HEALTH CARE/FAMILY PHYSICIANSPECIALIST

Why a GP solution?

General practitioners are at the forefront of the provision of primary medical care and have enormous potential to encourage patients to take greater responsibility for their health.Through a range of proven strategies, GPs may be able to influence patients to:change their lifestyleundergo screening for the early detection of a range of conditionspresent for health protecting vaccinationsmanage chronic conditions to improve quality of life

ONE OF PUBLIC HEALTH PROGRAM IN PRIMARY HEALTH SERVICES ~ FAMILY DOCTOR IS:

IMCI

WHAT IS IMCI ? IMCI (INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS) IS AN INTEGRATED APPROACH TO CHILD HEALTH THAT FOCUSES ON THE WELL-BEING OF THE WHOLE CHILD AND AIMED TO REDUCE DEATH, ILLNESS AND DISABILITY, AND TO PROMOTE IMPROVED GROWTH AND DEVELOPMENT AMONG CHILDREN 5 YEARS OF AGE.

THREE COMPONENT WORKING IN IMCI

FIRST LEVEL HEALTH CARE PROVIDERS

THE LOCAL HEALTH CARE DELIVERY SYSTEM

FAMILIES AND COMMUNITIES

CHILD SURVIVAL PROBLEM: 7 IN 10 OF THE CHILDREN < 5 YEARS DIE CAUSE OF PREVENTABLE AND TREATABLE CONDITIONS (ARI, DIARRHOEA, MALARIA, MEASLES AND MALNUTRITION) MANY SICK CHILDREN ARE NOT PROPERLY ASSESSED AND TREATED BY HEALTH CARE PROVIDERS THEIR PARENTS ARE POORLY ADVISED DIAGNOSTIC SUPPORT ARE INADEQUATE DRUGS AND EQUIPMENT ARE OFTEN SCARCEA SERIOUS CHALLENGEIMCI (WHO, UNICEF)

WHY IS IMCI BETTER THAN SINGLE CONDITION APPROACHES ? THE MOST IMPORTANT REALISATION ABOUT CHILD SURVIVAL IS THAT KILLER DISEASES OPERATE IN THE SAME ENVIRONTMENT OF POOR NUTRITION AND LACK IMMUNISATION TO PROTECT THE CHILD MAKING A SINGLE DIAGNOSIS IS IMPOSSIBLEIMCI - INTEGRATED STRATEGY WHICH TAKES INTO ACCOUNT THE VARIETY OF FACTORS THAT PUT CHILDREN AT SERIOUS RISK - IT ENSURES THE COMBINED TREATMENT OF THE MAJOR CHILDHOOD ILLNESSES, EMPHASIZING PREVENTION OF DISEASE THROUGH IMMUNIZATION AND IMPROVED NUTRITION

WHAT DOES THE IMCI PROGRAMME STRIVE TO DO ?STRATEGY:IN THE HEALTH CARE PROVIDERS TO PROMOTES THE ACCURATE IDENTIFICATION OF CHILDHOOD ILLNESSES IN OUTPATIENT SETTING, COMBINED TREATMENT ALL MAJOR ILLNESSES, STRENGTHENS THE COUNSELLING OF CARETAKERS AND SPEEDS UP THE REFERRAL OF SEVERELY ILL

IN THE HEALTH CARE DELIVERY SYSTEM MANPOWER TRAINING, MATERIAL AND BUDGET

IN THE HOME SETTING TO PROMOTES APPROPRIATE CARE SEEKING BEHAVIOURS, IMPROVED NUTRITION AND PREVENTIVE CARE, AND CORRECT IMPLEMENTATION OF PRESCRIBED CARE

HOW IS IMCI IMPLEMENTED ?

PHASE I : INTRODUCTION OF IMCI IN A COUNTRY (ORIENTATION OF DECISION MAKERS, THE ESTABLISHMENT OF NATIONAL MANAGEMENT AND COORDINATION GROUP, TRAINING OF KEY MINISTRY OF HEALTH STAFF.

PHASE II : GAINING EXPERIENCE THROUGH EARLY IMPLEMENTATION, DEVELOPMENT OF NATIONAL PLAN, SELECTION OF INITIAL DISTRICTS FOR IMPLEMENTATION, ADAPTATION OF CLINICAL GUIDELINES AND MATERIALS, TRAINING FACILITATORS AND PLANNING AT DISTRICT LEVEL.

PHASE III: EXPANSION OF ACTIVITIES AND COVERAGE